Balloon Angioplasty Essay

Coronary artery disease remains number one killer of the western civilization despite 40 years of aggressive drug and surgical interventions (Esselstyn). Usually, pharmaceutical drugs, such as statin, are given to try to slow the progression, but may provide uncomfortable side effects. In fact, the majority of patients discontinue statins within 1 year of treatment initiation (Maningat). Furthermore, surgery is performed to circumvent clogged arteries and literally bypass the symptoms. In the last year, 500,000 coronary bypass procedures were performed (Swaminathan et al). However, these surgeries can have significant risks, including the potential to cause further heart damage, stroke, and brain dysfunction. Thus, it is evident that these way of treatments may not be enough on its own, and that getting to the

(Mayo Clinic, 2013) Some surgical procedures used to treat CAD are angioplasty and coronary artery bypass surgery. (Mayo Clinic, 2013) The angioplasty surgery is when your doctor inserts a catheter to the blockage in the artery and threads the wire through the narrowed arteries. (Opening blocked coronary arteries: New questions about the old answer, nd., p.2) Once the balloon is in place, at the sight of the blockage, the balloon inflates which causes the plaque to crack and the artery to become free from blockage. (Opening blocked coronary arteries: New questions about the old answer, nd., p.2) The other surgical opinion for CAD is coronary artery bypass surgery is a procedure done by a doctor using a graft. (Mayo Clinic, 2013) The doctor will construct a graft to direct the blood flow around the blockage using existing blood vessels in the body. (Mayo Clinic, 2013) Due to the fact that this procedure requires open heart surgery, it is usually used for patients with several partial or full blockages. (Mayo Clinic, 2013)

1). Chest X-ray was normal. Initial laboratory studies were remarkable for white blood cells count of 12.1K, a creatine kinase MB fraction of < 3 mm was associated with significant reductions in restenosis and the rate of target vessel revascularization19. In SES-SMART trial patients were randomly assigned to receive a Sirolimus-eluting or bare-metal stent in small coronary artery. Sirolimus stent was associated with significant reductions in the rates of angiographic restenosis (primary outcome), target lesion revascularization and MI at 8 months20. The composite clinical endpoint ( death, non-fatal MI, ischemia- driven target lesion revascularization, and cerebrovascular accidents) was significantly lower with the sirolimus-eluting stent21. In the TAXUS V trial, in the subset of patients with small coronary arteries, the paclitaxel stent was associated with significant reductions in angiographic restenosis and target lesion revascularization at nine months compared to bare metal stents22. Although DES improves target lesion revascularization rates compared to bare-metal stents in small vessels, the absolute rates are still higher in small vessels than large

Fibrinolytic therapy uses drugs to break up blood clots. This therapy is used with heart attack patients to remove the blockage that caused the myocardial infarction. Another treatment option is percutaneous coronary intervention (PCI). PCI involves the placement of a catheter into the blocked artery to allow blood to flow. The purpose of this paper is to examine the outcomes of these two procedures and to suggest that percutaneous coronary intervention is superior to fibrinolytic therapy.

"In 2006, more than 690,000 open heart surgeries were performed in the United States. These included surgeries to correct and repair defective valves as well as coronary artery bypass surgery. As recently as 70 years ago, these surgeries would have been impossible. The heart lung machine had yet to be invented, allowing surgeons to temporarily stop and start the heart. Prior to its invention, the longest a heart could be stopped was 30 to 40 minutes---not enough time to complete extensive surgery" (Smith, 2009). Since then, a number of minimally invasive surgical procedures have been introduced that permit surgeons to perform a variety of surgeries, making smaller incisions that leave smaller scars, reduce the chance of infection, are less painful to the patient and necessitate shorter hospital stays. These include minimally invasive direct coronary artery bypass, off-pump coronary artery bypass, videoscopic surgery and robotic-assisted heart surgery.

“Coronary Artery Bypass Graft (CABG) surgery is a widely used surgical procedure for the relief of symptoms of Coronary Artery Disease” (Bagielia, Connerney, McLaughlin, Shapiro, & Sloan, 2001, p. 1766). Coronary Artery Disease is the narrowing of the blood vessels that supply oxygen and nutrients to the heart muscles. The buildup of fatty material within the walls of the arteries causes cardiac diseases (Coronary Artery Bypass Surgery,, 2010) .To resolve this issue, surgeons take veins and arteries from elsewhere in the patient’s body. Then, surgeons graft the veins and arteries to the coronary arteries to bypass the atherosclerotic narrowing and improve the blood supply to the heart muscles (Coronary Artery Bypass Surgery,, 2010). This procedure increases the blood flow to the heart by giving the blood a new route around the diseased or clogged artery (Bagielia, Connerney, McLaughlin, Shapiro, & Sloan, 2001).

Some lifestyle-related conditions and decisions increase the likelihood of a person having heart disease. Some examples are diabetes, overweight and obesity, poor diet, lack of physical activity and excessive consumption of alcohol. High blood pressure, low-density lipoprotein (BAD) cholesterol, and smoking are key risk factors for heart disease. LBD is considered to be "bad" cholesterol because having high levels can lead to accumulation in the arteries, which can cause heart disease and stroke. If you lower your blood pressure and cholesterol, and if you do not smoke, you will reduce your chances of having heart disease. Now, in case of emergency, angioplasty which is the best treatment needs to get done. In this case we need to kake in consideration that not all hospitals are capable to made the process, so we need to be aware of our options. After the angioplasty you should take a daily medication, which will help your heart adapt to the implanted stents and they will not close again, a phenomenon known as restenosis, his medication should not be forgotten any day in order to minimize future

One of the leading causes of death for men and women in the United States can be attributed to Coronary Artery Disease. In the medical world, treatments are ever-changing and improving the chance of survival from this disease. One such treatment, Percutaneous Coronary Intervention (PCI) with stent placement, is now used in more than 80% of CAD cases with an exceedingly high success rate (http://emedicine.medscape.com/article/161446-overview). With any procedure, there is a number of tools at the doctor’s fingertips, and a new experimental technology in the stent world has risen with temporary bio-absorbable stents. The following document will briefly explain the procedure and their use in percutaneous coronary intervention.

1. Angioplasty: Kereiakes and Wetherill write that “angioplasty is a procedure in which a heart doctor inserts a balloon catheter over a thin wire across an artery. The balloon is inflated and compresses the plaque to clear the arteries of any blockage.”(p. 106-107).

A second study authored in 2012 was conducted with the goal of summarizing "single-center real-world experience with percutaneous coronary intervention (PCI) stenting of unprotected left main coronary artery (ULMCA)" (Leung et al.). The parameters of this study were designed so that, "between January 2005 and December 2008, PCI-stenting was performed on 125 patients with ULMCA lesions" while significant "cinical and procedural data were recorded at the time of

The evolution of percutaneous coronary intervention (PCI) from plain old balloon angioplasty (POBA) in 1977, to bare metal stents (BMS) in 1986, through the revolutionary introduction of drug-eluting stents (DES) in 2003 which successfully treated the “Achilles heal” of BMS (neointimal proliferation and restenosis) has provided significant iterative improvement in platform design and performance. Adverse clinical events to 1-year following stent

The stent will be placed where it can be expanded to hold the artery open. Some stents are designed to simply keep the artery held open. Other stents used are drug-eluting stents. These stents are coated with pharmacologic agents that work to prevent restenosis of the artery.

Surgical embolectomy is highly suggested for patients with thrombi in right side of the heart. Embolectomy is the surgical removal of emboli/thrombi (blood clots) which blocking the blood vessel. It is best indicated in patients whom the thrombolytic therapy in contraindicated and a therapeutic option in those who fail fibrinolysis. This procedure can be done surgically or using a catheter. Surgical embolectomy is done by making an incision into the vessels mainly blocked artery by open surgery. It is limited by costs, large medical centers and needs experienced surgeon because it has high mortality rate among elderly. Patients have high risk of developing intracranial hemorrhage due to administration of heparin anticoagulation in extracorporeal

Patients who suffer from mutivessel coronary artery disease have different treatments for their cases, there is no one perfect option, it depends on the patient condition or severity of the disease, or even patient's preference of the treatment after been told all the information about treatment options. To have clear idea about the different between coronary artery bypass grafting against percutaneous coronary interventions, I searched for articles, understood the different between the two of them, read the result of several studies then I determined my position regarding this debate. First the definitions of CABG and PCI:

For example, with coronary artery disease, two therapies are commonly used: stents (implantable devices) and coronary artery bypass graft (CABG) surgery. Differences between outcomes with stenting and with CABG are a point of controversy (Hannan et al., 2008; Ryan et al., 2006). However, a recent study comparing the treatment outcomes of all